Interest in the integration of traditional and biomedical health practices is growing globally, as indicated by the WHO’s 2023 global summit on traditional medicines. The place of traditional medicines in a biomedical health system is also gaining attention locally in the Singaporean context, where recent health policy changes have emphasised an integrative approach that prioritises continuity of care to improve health outcomes. Yet, this drive towards increasing integration between different medical paradigms presents ethical and philosophical challenges that are underexplored. In addition to the familiar worries about efficacy, risks of drug-herb interaction and the efficient use of resources, this paper argues that integration efforts must also contend with deeper ontological and normative divides that exist between medical paradigms. For the purposes of our discussion, we focus on traditional Chinese medicine and biomedicine within Singapore. While we do not go so far as to argue that these identified challenges are insurmountable, we claim that they must be made explicit, understood and responded to before the aim of integrating traditional and biomedical practices can be realised effectively. We conclude by proposing new orientations for collaborative practice between divergent medical traditions.